New recommended dietary guidelines, delivered to the federal government last Friday by its hand-picked advisory panel, are as notable for what they don't clearly state as for what they do.
Nearly a year's work was boiled down to nine concise bullet points that — with oversight from two federal agencies, the Department of Health and Human Services and the Department of Agriculture — will be crafted into a new official stance on how the government thinks Americans should eat.
The nine directives are broad — too broad, some believe. Americans should be "physically active" every day. Fats and carbohydrates should be chosen wisely.
In one sense, the recommendations solidly endorse years of good basic advice from mainstream nutritionists, most of whom have shunned fads like low-carb. Eat moderately, eat a balanced diet, get more exercise.
How useful are the new guidelines?
Yet subtle changes from the last set of guidelines, unveiled in 2000, and the relegation of some key points to the fine print, have critics wondering how useful the new guidelines will be.
"What many people will take away from the guidelines are the headlines," says David Schardt, senior nutritionist for the Center for Science in the Public Interest. "We were disappointed that those headlines don't convey exactly what the committee is recommending."
Actually, the CSPI — one of the food industry's most vocal critics — has largely supported the new guidelines, which the 13-member advisory panel devised using what it called "a fresh approach" that not only weighed the science behind possible recommendations, but assigned research studies relative weight based on their methods and scope.
Among the recommendations:
- Eat a variety of foods from all the basic food groups. The recommendations focus on food "commodities" — not processed items.
- Seek out more dark green vegetables, whole grains, legumes, fruits, milk and fiber. Eat less refined grains and fats.
- Limit salt intake to 2,300 mg per day, a lower figure than the last recommendation and on par with other agencies' recommendations.
- Avoid trans fats, often considered the most unhealthy of fats.
Some of this advice either was new or went beyond previous guidelines, which federal law requires to be updated every five years. The committee set a cap of 1 percent consumption on trans fats, which food companies must list on labels by 2006 under a new Food and Drug Administration rule.
It endorsed at least two servings of fish per week. It again told adults to get at least 30 minutes of physical activity daily, though it told those wishing to lose weight to aim for 60.
Few foods off limits
Yet many of the more specific recommendations, and the strongest language, are relegated to the fine print. Specific protein sources get few mentions, though the full report discusses a few, including some for vegetarians. Most are evaluated in their "lowest fat form": nonfat milk, skinless chicken.
Indeed, aside from trans fats and refined starches, the committee seems reluctant to declare specific foods or ingredients off limits. Rather, it endorsed "discretionary calories" — those from added sugars and solid fats that are OK once basic nutritional needs have been fulfilled.
A 2,000-calorie diet might tolerate 208 discretionary calories, along with 5.5 ounces of meat or beans, plus at least three cups a week of dark green vegetables and so on.
"We're not coming down against anything, so if someone does enough exercise and they want to have a soda or candy bar, that's fine," Fergus Clydesdale, a member of the advisory panel and head of the food science department at the University of Massachusetts at Amherst, told MSNBC.com.
Some clear winners and losers did emerge in the recommendations, which federal scientists will review before the two agencies write final guidelines early next year.
America's low-carb industry will find little comfort in there. The biggest nod to the carb counters was the non-specific call to "choose carbohydrates wisely."
Dr. Stuart Trager, medical director for Atkins Nutritionals, calls that language "a testament" to carb crusader Dr. Robert Atkins. Atkins' company lobbied the advisory panel hard, and proposed its own alternate food pyramid, with proteins at the base and grains near the top.
Winners and losers
The committee saw it differently, recommending at least 3 ounces of whole grains per day; that much brown rice contains nearly 20 grams of carbohydrates, about the limit for the initial phase of the Atkins' diet. A half-cup of a legume like lentils contains about the same.
"Is there a new solution put forward by these recommendations that provides a solution to the obesity epidemic? I don't see one," Trager says. "I think that they're clearly too little and too vague."
The guidelines may not sit well with some food companies either, despite intense lobbying over the past year by everyone from cattlemen to potato growers. A focus on whole foods doesn't bode well for food processors, and the small number of discretionary calories doesn't leave much room for snack products.
By contrast, despite worries by trade groups like the National Potato Council, recommendations for starchy vegetables matched those for green veggies, and the largest category for vegetables is "other" — consumer's choice, as it were.
The variety of veggies is a relief to many nutritionists. "That's terrific," says dietician Katherine Tallmadge, an American Dietetic Association spokeswoman and author of "Diet Simple."
After intensive lobbying, the dairy industry also made itself heard. The committee endorsed at least 3 cups of milk per day.
How much of this is translated into a top-line message remains to be seen. The two agencies must streamline them, with help from Porter Novelli, the PR agency hired by the government to overhaul the much-debated food pyramid. Even that may not quell concerns about their efficacy.
"Fortunately," Tallmadge says, "I don't really rely on these guidelines to tell me what to tell my clients."
'Let's do it this way'
The current debate may be the most politicized ever. Even the committee's review of scientific research came under fire. Members considered evidence not on an equal playing field, as was previously done, but were directed by the government to subjectively weigh studies based on their methods and scope.
"That was their charge, so to speak," says HHS spokesman Bill Pierce. "It wasn't a recognition that it wasn't done in the past. It was a recognition that let's do it this way."
Those who see loopholes in the recommendations simply don't buy the argument. "I'm sorry," says New York University nutrition researcher Marion Nestle, "what did they think the previous committees were doing?"
The most significant point of contention: Prior guidelines plainly told Americans to "moderate your intake of sugars."
In what the new report acknowledges as a "major departure," that language is gone, though committee members emphasize the importance of reducing added sugars.
"Absolutely shocking," Nestle says. "If it's important, where's the guideline?"
Panel members argued their advice on carbs implicitly includes a warning on sugary treats. "Decreased intake of such foods is recommended," the report recommends.
Like what? A determined reader can find a list buried in the tables: soda, candy, sweetened baked goods and so on. But the report is less concerned with sugar itself than a tendency for Americans who eat added-sugar foods to get short-changed on nutrients.
Scuffling over sugar
Clydesdale, who also chairs the Institute of Food Technologists' government relations panel, says the committee found scant evidence to repeat the high-profile message from 2000. It cited deep in the report one study by Harvard researcher Matthias Schulze showing that changes in sugar consumption had more weight-loss impact than the consumption itself.
Battles over the government's sugar recommendations have surfaced before. Last April, a report from the Food and Agriculture Organization and the World Health Organization, both U.N. agencies, recommended that added sugars compose no more than 10 percent of a healthy diet. HHS and the USDA announced the U.N. recommendations would likely be followed in the 2005 dietary guidelines. That prompted the Center for Regulatory Effectiveness, a privately funded watchdog group to contest the agencies' plans.
The center, founded by Reagan administration official Jim Tozzi, filed a complaint using a 2000 law known as the Data Quality Act. The legislation lets White House budget officials review how federal agencies use scientific data, and lets private parties contest the use of that data.
Some scientists and advocacy groups have criticized the act as a way for companies to stall or reverse federal regulations that could adversely impact them.
The privately funded CRE, which does not disclose its donors, contested any use of the U.N. findings because, it said, the report "does not meet the U.S. Government's data quality standards."